Hanger H Carl, Fletcher Valerie, Sidwell Andrew
Older Persons Health Specialist Service, The Princess Margaret Hospital, Christchurch, New Zealand.
N Z Med J. 2011 Jun 24;124(1337):24-32.
Acute medical admissions are increasing and potentially avoidable admissions (PAA) from residential care facilities (RCF) have been blamed. Estimates for the proportion of PAA from RCFs vary enormously in the literature. This study aimed to prospectively determine the level of PAA to a New Zealand hospital.
Two cohorts of consecutive acute medical admissions of older (65 years and older) people from RCFs were reviewed (one retrospective and one prospective). Discharge domicile and survival at 6 months were determined for all patients. PAAs were determined by the treating general physician/geriatrician in the prospective cohort.
Admissions from RCF are a very heterogeneous group with a wide range of diagnoses, levels of dependency and outcomes. Most admissions (88%) from lower level care (LLC) were appropriate and most returned to their usual RCF on discharge. Patients from higher level care (HLC) patients had poorer outcomes (5/8 died in the acute hospital and only 1/8 alive at 6 months). Twenty percent of all RCF admissions were potentially avoidable and could have been managed in a different setting
Most admissions from RCF were appropriate. However for a minority of admissions, other models of care within RCFs and community care are needed to provide alternative options of care. These may reduce some acute hospital admissions.
急性医疗入院人数不断增加，而来自养老院的潜在可避免入院（PAA）一直受到指责。文献中对养老院PAA比例的估计差异极大。本研究旨在前瞻性地确定一家新西兰医院的PAA水平。
对两组来自养老院的连续急性医疗入院的老年人（65岁及以上）进行了回顾（一组回顾性研究，一组前瞻性研究）。确定了所有患者的出院住所和6个月时的生存率。PAA由前瞻性队列中的主治普通内科医生/老年病科医生确定。
来自养老院的入院患者是一个非常 heterogeneous 的群体，诊断范围、依赖程度和结局各不相同。大多数来自低级别护理（LLC）的入院患者是合适的，大多数患者出院后返回了他们通常所在的养老院。来自高级别护理（HLC）的患者结局较差（8例中有5例在急性医院死亡，6个月时只有1例存活）。所有养老院入院患者中有20%是潜在可避免的，本可在不同环境中进行管理。
大多数来自养老院的入院患者是合适的。然而，对于少数入院患者，需要在养老院和社区护理中采用其他护理模式，以提供替代护理选择。这些措施可能会减少一些急性医院入院人数。
